Early Intervention May Prevent Alcohol Use Disorder

Many Americans have substance use disorders, but do not seek treatment for various reasons. For those who do seek treatment, drug and psychological therapy may not offer an adequate solution, which makes prevention important.

A new study supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) has found a potential prevention option for alcohol use disorder in certain populations. The study authors found that community-based and individual-level prevention strategies was able to reduce alcohol use among American Indian and rural youth.

“This important study underscores our commitment to finding evidence-based solutions for alcohol problems in American Indian and other underserved populations,” said NIAAA Director George F. Koob, PhD. “This study is one of the largest alcohol prevention trials ever conducted with an American Indian population, and the first to demonstrate the effectiveness of screening and brief counseling intervention in significantly reducing youth alcohol use at a community level.”

American Indian teenagers have been observed to consume alcohol at a comparable rate to other similarly aged groups. However, American Indian teenagers are more likely to use alcohol earlier, and have a high rate of alcohol use disorder and other problems, according to the study. Rural youths are also known to have an increased risk for alcohol misuse.

Preventing alcohol use among rural and American Indian teenagers is important, but these individuals have been traditionally underrepresented in studies of initiatives to reduce underage drinking.

Investigators at the Rollins School of Public Health at Emory University partnered with the Cherokee Nation to launch a trial of 2 different initiatives to prevent drinking among youth.

The first strategy was Communities Mobilizing for Change on Alcohol (CMCA), a community-based organization to reduce alcohol access, use, and consequences among underage individuals. The second strategy, CONNECT, is an individual-based screening and intervention approach that is implemented in schools.

These strategies were enacted in northeastern Oklahoma, which is home to 40% of the Cherokee Nation tribe plus whites, and racial/ethnic minorities, according to the study. Included in the study were 1623 students enrolled in a single high school who were in 9^th or 10^th grade at baseline.

“Community organizing has been used effectively in multiple other health intervention trials and appeared to be an optimal strategy to engage diverse citizens in these multicultural communities,” Dr Komro said.

In CMA, teams of adults are trained to enact policies and take action to reduce access to alcohol. In CONNECT, a school social worker would conduct a health consultation with each student every semester to discuss alcohol consumption. Students who partake in high-risk alcohol use are required to attend follow-up sessions, and are referred to treatment if appropriate, according to the study.

Students included in the study were randomized to receive 1 or both of the interventions, with students receiving no intervention as the control group.

The study authors discovered that self-reporting of alcohol use, including any or heavy use, within 30 days prior to the interview, decreased among youths receiving 1 or more interventions, compared with those not receiving the intervention, according to the study.

“The 2 distinct interventions alone and in combination resulted in similar patterns of effect across time,” Dr Komro said. “Interestingly, we found no evidence that the 2 interventions combined had significantly greater effects than either alone.”

These findings may even translate to the general population, where underage alcohol use and alcohol misuse disorder is common.

Although alcohol use among rural and American Indian use is high, these community- and individual-based interventions may effectively address early alcohol use in these individuals, the study concluded.